Newborn infants must sometimes be cared for at a hospital for some time after birth, particularly in the case of premature or otherwise challenged babies. It is well recognized that it is advantageous for the infant to be fed its mother's natural breast milk; hence, mothers of infants requiring hospital care are encouraged to express milk for storage at the hospital, for administration to the baby when the mother is absent.
Many diseases, such as HIV, hepatitis and syphilis can be transmitted by human breast milk. For this reason, it is preferable that the baby receives only milk from its own mother. In addition, human breast milk that is improperly stored may harbour dangerous bacteria, which could harm the child.
The process for managing mothers' milk in hospital nurseries is generally as follows. Mothers are provided with a breast pump to help them express milk into appropriate containers at home. The mother is expected to label the containers with identification information and the date and time of expression then return the milk to the hospital. At the hospital, the milk is stored in a common refrigerator along with milk from other mothers.
A caregiver responsible for managing the baby's diet creates a feeding order that includes the volume of milk to be fed, and specifies any dietary supplements that must be added. It is usual practice to include an order for baby formula with the order, in case there is insufficient mother's milk available. Based on the order, units of milk are prepared for the baby and are labelled with the baby's identification, using the oldest mother's milk available.
When the baby requires feeding, the caregiver selects a prepared milk unit from the refrigerator and checks to make sure it is for the intended baby.
The selected milk unit is then fed to the baby, following a procedure that may include aspirating the baby's stomach to see if it has completely digested the previous feeding, feeding the baby the new milk, and recording the time taken and quantity fed. This information is useful for managing the overall nutrition of the infant.
There are several areas of risk with this process. It is possible that milk from the wrong mother may be selected by the caregiver; that an older milk unit might be missed, resulting in wastage; that milk may have been stored too long and may no longer be safe; and that the correct feeding procedure may not be followed. Other than training of caregivers, little is available to reduce the risk of the process.